I 

112TH CONGRESS 

1ST SESSION H. R. 1448 

To amend the Public Health Service Act with respect to eating disorders, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 8, 2011 

Ms. BALDWIN (for herself, Mr. CONNOLLY of Virginia, Mr. JOHNSON of Georgia, Mr. LOEBSACK, Mrs. MALONEY, Mr. MORAN, Mr. NADLER, Ms. 

SCHAKOWSKY, and Mr. HASTINGS of Florida) introduced the following 

bill; which was referred to the Committee on Energy and Commerce, and 

in addition to the Committees on Ways and Means, Oversight and Government Reform, and Education and the Workforce, for a period to be 

subsequently determined by the Speaker, in each case for consideration 

of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend the Public Health Service Act with respect to 

eating disorders, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Federal Response to 

5 Eliminate Eating Disorders Act of 2011’’. 

6 SEC. 2. TABLE OF CONTENTS. 

7 The table of contents of this Act is as follows: 


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Sec. 1. Short title. 

Sec. 2. Table of contents. 

Sec. 3. Findings. 

Sec. 4. Definition. 

TITLE I—RESEARCH 

Sec. 101. Activities to improve eating disorder-related research and funding. 

Sec. 102. Eating disorders surveillance and research program. 

TITLE II—EDUCATION AND PREVENTION 

Sec. 201. Study of mandatory BMI reporting in school. 

Sec. 202. Training and education. 

Sec. 203. Health professional education and training. 

Sec. 204. Education and training for all health professionals. 

Sec. 205. Education and training for school and higher education professionals. 

Sec. 206. Eating disorder research and report. 

Sec. 207. Public service announcements. 

Sec. 208. Sense of Congress. 

TITLE III—TREATMENT 

Sec. 301. Coverage for treatment for eating disorders under group health plans, 

individual health insurance coverage, and FEHBP. 

TITLE IV—IMPROVING AVAILABILITY AND ACCESS TO 

TREATMENT 

Sec. 401. Medicaid coverage for eating disorder treatment services. 

Sec. 402. Grants to support patient advocacy. 

1 SEC. 3. FINDINGS. 

2 The Congress finds as follows: 

3 (1) Risk of death among individuals with ano4 rexia nervosa is 11 times greater than their same 

5 age peers without anorexia. 

6 (2) Health consequences such as osteoporosis 

7 (brittle bones), gastrointestinal complications, and 

8 dental problems are significant health and financial 

9 burdens throughout life. 

10 (3) An estimated 5,000,000 to 10,000,000 

11 women and girls and 1,000,000 men and boys suffer 

12 from eating disorders, including anorexia nervosa, 


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1 bulimia nervosa, and eating disorders not otherwise 

2 specified (EDNOS) (including binge eating dis3 order). The lifetime prevalence of all eating dis4 orders in America is 0.6 to 4.5 percent. 

5 (4) Anorexia nervosa is an eating disorder char6 acterized by self-starvation and excessive weight loss. 

7 An estimated 0.9 percent of American women and 

8 0.3 percent of American men will suffer from ano9 rexia nervosa in their lifetime. 

10 (5) Anorexia nervosa is associated with serious 

11 health consequences including heart failure, kidney 

12 failure, osteoporosis, and death. 

13 (6) Bulimia nervosa is an eating disorder char14 acterized by excessive food consumption followed by 

15 inappropriate compensatory behaviors, such as self16 induced vomiting, misuse of laxatives, fasting, or ex17 cessive exercise. An estimated 1.5 percent of Amer18 ican women and 0.5 percent of American men will 

19 suffer from this disorder in their lifetime. 

20 (7) Bulimia nervosa is associated with cardiac, 

21 gastrointestinal, and dental problems including ir22 regular heartbeats, gastric rupture, peptic ulcer, 

23 tooth decay, and death. 

24 (8) Binge eating disorder is characterized by 

25 frequent episodes of uncontrolled overeating. Binge 


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1 eating disorder is common: an estimated 3.5 percent 

2 of American women and 2.0 percent of American 

3 men will suffer from this disorder in their lifetime. 

4 (9) Binge eating is associated with obesity, 

5 heart disease, gall bladder disease, and diabetes. 

6 (10) Many more suffer from some, but not all, 

7 of the symptoms of anorexia nervosa, bulimia 

8 nervosa, or binge eating disorder, which is referred 

9 to as eating disorders not otherwise specified 

10 (EDNOS). Between 4 percent and 20 percent of 

11 young women practice unhealthy patterns of dieting, 

12 purging, and binge eating. 

13 (11) Eating disorders are more common in 

14 women, but they do occur in men. Rates of binge 

15 eating disorder are similar in females and males. 

16 (12) Eating disorders usually appear in adoles17 cence and are associated with substantial psycho18 logical problems, including depression, substance 

19 abuse, and suicide. Eating disorders also develop in 

20 younger children and adults, compromising health 

21 and daily functioning. For children 12 years of age 

22 and younger, hospitalizations for eating disorders in23 creased by 119 percent between 1999 and 2006. 

24 (13) Eating disorders are found across races, 

25 ethnicities, and socioeconomic groups in the United 


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1 States. White females are more likely to suffer from 

2 anorexia, while African-American girls are especially 

3 vulnerable to developing eating disorders that involve 

4 binge eating. Body dissatisfaction in young girls has 

5 been shown in White, African-American, Hispanic, 

6 and Asian girls. 

7 SEC. 4. DEFINITION. 

8 In this Act, the term ‘‘eating disorder’’ includes ano9 rexia nervosa, bulimia nervosa, and eating disorders not 

10 otherwise specified (EDNOS) (including binge eating dis11 order), as defined in the fourth edition of ‘‘Diagnostic and 

12 Statistical Manual of Mental Disorders’’ or, if applicable, 

13 the most recent successor edition. 

14 TITLE I—RESEARCH 

15 SEC. 101. ACTIVITIES TO IMPROVE EATING DISORDER-RE16 LATED RESEARCH AND FUNDING. 

17 Title IV of the Public Health Service Act (42 U.S.C. 

18 281 et seq.) is amended by adding at the end the fol19 lowing: 


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1 ‘‘PART J—EATING DISORDER-RELATED 

2 ACTIVITIES 

3 ‘‘SEC. 499A. AUTHORITY OF THE DIRECTOR OF THE NA4 TIONAL INSTITUTES OF HEALTH RELATING 

5 TO EATING DISORDERS. 

6 ‘‘(a) IDENTIFYING TOTAL EXPENDITURES ON EAT7 ING DISORDERS.—The Director of NIH, in coordination 

8 with the National Institute of Mental Health, the Office 

9 of Research on Women’s Health, and other institutes of 

10 the National Institutes of Health, shall identify the total 

11 amount of expenditures, both intramural and extramural, 

12 by the National Institutes of Health for eating disorders 

13 for each of fiscal years 2009 and 2010. 

14 ‘‘(b) BUDGET FOR EATING DISORDERS RESEARCH

15 AND COORDINATION OF ACTIVITIES AND PROGRAMS.— 

16 The Director of NIH, based on the strategic plan devel17 oped under subsection (c), shall— 

18 ‘‘(1) develop and oversee the implementation of 

19 a scientifically justified budget for research on eat20 ing disorders at the National Institutes of Health; 

21 ‘‘(2) coordinate all research activities and pro22 grams on eating disorders at the institutes, centers, 

23 and divisions of the National Institutes of Health; 

24 and 

25 ‘‘(3) evaluate all such activities and programs. 


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1 ‘‘(c) STRATEGIC PLAN FOR EATING DISORDERS RE2 SEARCH.— 

3 ‘‘(1) IN GENERAL.—Not later than 1 year after 

4 the date of the enactment of this section, the Direc5 tor of NIH shall develop, in consultation with lead6 ing eating disorder researchers, and oversee the im7 plementation of a comprehensive, long-range plan 

8 for the conduct and support of research on eating 

9 disorders by the institutes, centers, and divisions of 

10 the National Institutes of Health. 

11 ‘‘(2) REQUIREMENTS.—The plan developed 

12 under paragraph (1) shall— 

13 ‘‘(A) be updated on an annual basis; 

14 ‘‘(B) identify critical scientific questions 

15 related to eating disorders and establish prior16 ities among such questions; 

17 ‘‘(C) based on the priorities established 

18 under subparagraph (B), specify the short- and 

19 long-range objectives to be achieved, and esti20 mate the resources needed to achieve these ob21 jectives; 

22 ‘‘(D) evaluate the sufficiency of existing re23 search programs on eating disorders to meet 

24 the objectives specified under subparagraph (C), 


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1 and establish objectives, timelines, and criteria 

2 for evaluating future research programs; 

3 ‘‘(E) be coordinated with the activities of 

4 the Centers of Excellence receiving funds under 

5 section 499B(b); and 

6 ‘‘(F) make recommendations for changes 

7 to existing research programs on eating dis8 orders. 

9 ‘‘(d) BUDGETARY AUTHORITY.— 

10 ‘‘(1) IN GENERAL.—The Director of NIH 

11 shall— 

12 ‘‘(A) in accordance with the strategic plan 

13 developed under subsection (c), annually pre14 pare and submit to Congress a scientifically jus15 tified budget estimate for research on eating 

16 disorders to be conducted within the agencies of 

17 the National Institutes of Health, which shall 

18 include the amount of funds that will be re19 quired for— 

20 ‘‘(i) the continued funding of ongoing 

21 discretionary program initiatives at the in22 stitutes, centers, and divisions of the Na23 tional Institutes of Health; and 

24 ‘‘(ii) the funding of new and com25 plementary program initiatives; and 


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1 ‘‘(B) receive all research funds for eating 

2 disorders described in subparagraph (A), and 

3 allocate those funds to the institutes, centers, 

4 and divisions of the National Institutes of 

5 Health. 

6 ‘‘(2) EFFECTIVE DATE.—Paragraph (1)(B) 

7 shall become effective in the fiscal year following the 

8 submission of the first eating disorder budget de9 scribed in paragraph (1)(A). 

10 ‘‘(e) EVALUATION AND REPORT.— 

11 ‘‘(1) EVALUATION.—The Director of NIH shall 

12 evaluate the effect of this section on the planning 

13 and coordination of research programs on eating dis14 orders at the institutes, centers, and divisions of the 

15 National Institutes of Health, and the extent to 

16 which funding mandated under this section has fol17 lowed the recommendation of the strategic plan de18 veloped under subsection (c). 

19 ‘‘(2) REPORT.—Not later than 1 year after the 

20 date of enactment of this section, the Director of 

21 NIH shall prepare and submit to the Committee on 

22 Energy and Commerce and the Committee on Ap23 propriations of the House of Representatives, and 

24 the Committee on Health, Education, Labor, and 

25 Pensions and the Committee on Appropriations of 


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1 the Senate, a report based on the evaluation de2 scribed in paragraph (1). 

3 ‘‘(f) DEFINITIONS.—In this part, the term ‘eating 

4 disorder’ includes anorexia nervosa, bulimia nervosa, and 

5 eating disorders not otherwise specified (EDNOS) (includ6 ing binge eating disorder), as defined in the fourth edition 

7 of ‘Diagnostic and Statistical Manual of Mental Disorders’ 

8 or, if applicable, the most recent successor edition. 

9 ‘‘SEC. 499B. EXPANSION, INTENSIFICATION, AND COORDI10 NATION OF ACTIVITIES OF NATIONAL INSTI11 TUTES OF HEALTH WITH RESPECT TO RE12 SEARCH ON EATING DISORDERS. 

13 ‘‘(a) IN GENERAL.— 

14 ‘‘(1) EXPANSION OF ACTIVITIES.—The Director 

15 of NIH shall expand, intensify, and coordinate the 

16 activities of the National Institutes of Health with 

17 respect to research on eating disorders. 

18 ‘‘(2) ADMINISTRATION OF PROGRAM; COORDI19 NATION AMONG AGENCIES.—The Director of NIH 

20 shall carry out this section acting through the Direc21 tor of the National Institute of Mental Health, and 

22 in collaboration with the Director of the Eunice 

23 Kennedy Shriver National Institute of Child Health 

24 and Human Development, the Director of the Na25 tional Institute of Diabetes and Digestive and KidVerDate Mar 15 2010 23:19 Apr 11, 2011 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1448.IH H1448

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1 ney Diseases, the Director of the Office of Research 

2 on Women’s Health, and any other agencies or of3 fices of the National Institutes of Health that the 

4 Director determines appropriate. 

5 ‘‘(3) TASK FORCE.— 

6 ‘‘(A) ESTABLISHMENT.—Before making 

7 grants under subsection (b) for Centers of Ex8 cellence, the Director of NIH shall establish a 

9 task force (in this paragraph referred to as the 

10 ‘task force’) consisting of— 

11 ‘‘(i) representatives of the institutes, 

12 centers, and divisions of the National Insti13 tutes of Health, as determined appropriate 

14 by the Director; 

15 ‘‘(ii) eating disorders researchers, cli16 nicians, and patient advocacy groups; and 

17 ‘‘(iii) the general public. 

18 ‘‘(B) DUTIES.—The task force shall— 

19 ‘‘(i) assist researchers in developing 

20 applications and applying for grants and 

21 contracts to be awarded for Centers of Ex22 cellence under subsection (b); 

23 ‘‘(ii) conduct a thorough examination 

24 of the field of eating disorders, create a list 

25 of priorities for eating disorders research, 


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1 and develop a matrix of action items for 

2 such research; and 

3 ‘‘(iii) conduct meetings to address 

4 issues with respect to eating disorders re5 search, including guiding principles of Cen6 ters of Excellence under subsection (b); de7 velopment of strategic research priorities; 

8 strategies for recruiting new scientists into 

9 the field of eating disorders and providing 

10 them with high-quality training; priorities 

11 and best practices for basic research, clin12 ical research, treatment research, and pre13 vention research; and development of a re14 search infrastructure nationwide. 

15 ‘‘(b) CENTERS OF EXCELLENCE.— 

16 ‘‘(1) GRANTS.— 

17 ‘‘(A) IN GENERAL.—In carrying out sub18 section (a)(1), the Director of NIH shall award 

19 grants and contracts to public or nonprofit pri20 vate entities, including universities, to— 

21 ‘‘(i) conduct research on eating dis22 orders designed to improve understanding 

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1 logical sequelae of and recovery from eat2 ing disorders; 

3 ‘‘(ii) conduct training to perform such 

4 research; and 

5 ‘‘(iii) pay all or part of the cost of 

6 planning, establishing, improving, and pro7 viding basic operating support for such re8 search and training. 

9 ‘‘(B) CENTERS OF EXCELLENCE.—For 

10 purposes of this section, an entity that receives 

11 a grant or contract under subparagraph (A) 

12 shall be referred to as a Center of Excellence. 

13 ‘‘(2) RESEARCH.— 

14 ‘‘(A) IN GENERAL.—Each Center of Excel15 lence shall conduct basic research, clinical re16 search, or both into eating disorders. 

17 ‘‘(B) REQUIREMENTS.—The research con18 ducted by a Center of Excellence pursuant to 

19 subparagraph (A)— 

20 ‘‘(i) shall be designed to improve un21 derstanding of the etiology, early identi22 fication, prevention, best treatment, med23 ical and psychological sequelae of and re24 covery from eating disorders; 


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1 ‘‘(ii) shall be conducted in the fields of 

2 basic, clinical, prevention, and intervention 

3 sciences; and 

4 ‘‘(iii) should include— 

5 ‘‘(I) studies clarifying the 

6 nosology and assessment of eating dis7 orders; 

8 ‘‘(II) investigations to determine 

9 the biological, psychosocial, and be10 havioral risk factors that might ap11 pear in early childhood; 

12 ‘‘(III) studies of promising treat13 ments for eating disorders; 

14 ‘‘(IV) evaluation of prevention 

15 programs for eating disorders; and 

16 ‘‘(V) studies of the medical, psy17 chological, and social sequelae of eat18 ing disorders. 

19 ‘‘(C) EQUAL REPRESENTATION OF RE20 SEARCH AREAS.—In awarding grants and con21 tracts under paragraph (1), the Director of 

22 NIH shall, to the extent practicable and appro23 priate, ensure that each of the research areas 

24 required by clauses (i) and (ii) of subparagraph 

25 (B) are equally represented. 


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1 ‘‘(3) TRAINING TO PERFORM EATING DIS2 ORDERS RESEARCH.—Each Center of Excellence 

3 shall provide at least 3 positions for doctoral level 

4 and post-doctoral level research trainees. 

5 ‘‘(4) SERVICES FOR PATIENTS.— 

6 ‘‘(A) IN GENERAL.—A Center of Excel7 lence may expend amounts provided under a 

8 grant or contract under such paragraph to 

9 carry out a program to make individuals aware 

10 of opportunities to participate as subjects in re11 search conducted by such Centers. 

12 ‘‘(B) REFERRALS AND COSTS.—A program 

13 carried out under subparagraph (A) may, in ac14 cordance with such criteria as the Director of 

15 NIH may establish, provide to the subjects de16 scribed in such subparagraph, referrals for 

17 health, mental health, and other services, and 

18 such patient care costs as are required for re19 search. 

20 ‘‘(C) AVAILABILITY AND ACCESS.—The ex21 tent to which a Center of Excellence can dem22 onstrate availability and access to clinical serv23 ices shall be considered by the Director of NIH 

24 in decisions about awarding grants or contracts 


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1 to applicants that meet the scientific criteria for 

2 funding under this section. 

3 ‘‘(5) COORDINATION OF CENTERS OF EXCEL4 LENCE.— 

5 ‘‘(A) IN GENERAL.—The Director of the 

6 National Institute of Mental Health shall, as 

7 appropriate, provide for the coordination of in8 formation among Centers of Excellence and en9 sure regular communication between such Cen10 ters. 

11 ‘‘(B) PERIODIC REPORTS.—The Director 

12 of the National Institute of Mental Health may 

13 require the periodic preparation of reports on 

14 the activities of Centers of Excellence and the 

15 submission of such reports to the Director. 

16 ‘‘(C) COLLECTION AND STORAGE OF

17 DATA.—The Director of the National Institute 

18 of Mental Health shall establish and fund 

19 mechanisms and entities for collecting, storing, 

20 and coordinating data collected by Centers of 

21 Excellence and data generated from public and 

22 private research partnerships. 

23 ‘‘(6) ORGANIZATION.—Each Center of Excel24 lence shall use the facilities of a single institution, 

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1 tutions, meeting such requirements as may be pre2 scribed by the Director of NIH. 

3 ‘‘(7) NUMBER; DURATION; ADDITIONAL PERI4 ODS.— 

5 ‘‘(A) IN GENERAL.—The Director of NIH 

6 shall award grants and contracts to not fewer 

7 than 3 entities under paragraph (1). 

8 ‘‘(B) DURATION.—Except as provided in 

9 subparagraph (C), a grant or contract awarded 

10 under paragraph (1) shall not exceed a period 

11 of 5 years. 

12 ‘‘(C) ADDITIONAL PERIODS.— 

13 ‘‘(i) EXTENSION.—The period of a 

14 grant or contract awarded under para15 graph (1) may be extended 1 or more addi16 tional periods not exceeding a total of 5 

17 years if the operations of the Center of Ex18 cellence involved have been reviewed by an 

19 appropriate technical and scientific peer 

20 review group (including investigators from 

21 the field of eating disorders) established by 

22 the Director of NIH and the group has 

23 recommended to the Director that such pe24 riod should be extended. 


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1 ‘‘(ii) AMOUNT.—The amount of any 

2 grant or contract under paragraph (1) for 

3 an additional period described in clause (i) 

4 shall not exceed $2,000,000 per fiscal year. 

5 ‘‘(D) PUBLIC INPUT.—In carrying out this 

6 section, the Director of NIH shall provide for a 

7 means through which the public can obtain in8 formation on the existing and planned pro9 grams and activities of the National Institutes 

10 of Health with respect to eating disorders and 

11 through which the Director can receive com12 ments from the public regarding such programs 

13 and activities. 

14 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

15 is authorized to be appropriated to carry out this section, 

16 $20,000,000 for each of fiscal years 2012 through 2016. 

17 Amounts appropriated under this subsection shall be in 

18 addition to any other amounts appropriated for such pur19 pose. 

20 ‘‘SEC. 499C. COLLABORATIVE PROGRAMS OF RESEARCH IN 

21 EATING DISORDERS. 

22 ‘‘(a) IN GENERAL.—The Director of NIH, acting 

23 through the Director of the National Institute of Mental 

24 Health, the Director of the National Institute of Diabetes 

25 and Digestive and Kidney Diseases, the Director of the 


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1 Eunice Kennedy Shriver National Institute of Child 

2 Health and Human Development, the Director of the Of3 fice of Research on Women’s Health, and any other agen4 cies or offices of the National Institutes of Health that 

5 the Director determines appropriate, in consultation with 

6 leading eating disorders researchers and clinicians, shall 

7 award grants and contracts to public or nonprofit private 

8 entities to pay all or part of the cost of planning, estab9 lishing, improving, and providing basic operating support 

10 for collaborative programs of research in eating disorders. 

11 ‘‘(b) RESEARCH.—Each program established under 

12 subsection (a)— 

13 ‘‘(1) shall conduct basic research, clinical re14 search, or both into eating disorders; and 

15 ‘‘(2) should conduct investigations into the 

16 cause, diagnosis, early detection, prevention and 

17 treatment of and recovery from eating disorders. 

18 ‘‘(c) COORDINATION OF PROGRAMS.— 

19 ‘‘(1) IN GENERAL.—The Director of NIH shall, 

20 as appropriate, provide for the coordination of infor21 mation among programs established under sub22 section (a), and Centers of Excellence receiving 

23 funding under section 499B, and ensure regular 

24 communication between such programs and Centers. 


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1 ‘‘(2) PERIODIC REPORTS.—The Director of 

2 NIH may require the periodic preparation of reports 

3 on the activities of the programs established under 

4 subsection (a) and the submission of such reports to 

5 the Director. 

6 ‘‘(3) COLLECTION AND STORAGE OF DATA.— 

7 The Director of NIH shall establish and fund mech8 anisms and entities for collecting, storing, and co9 ordinating data collected by the programs estab10 lished under subsection (a) and data generated from 

11 public and private research partnerships. 

12 ‘‘(d) ORGANIZATION.—Each program that receives 

13 funding under subsection (a) shall be formed from a con14 sortium of cooperating institutions, meeting such require15 ments as may be prescribed by the Director of NIH. 

16 ‘‘(e) NUMBER AND DURATION.— 

17 ‘‘(1) IN GENERAL.—The Director shall provide 

18 for the establishment of not fewer than 4 programs 

19 under subsection (a). 

20 ‘‘(2) DURATION.—Except as provided in para21 graph (3), a grant or contract awarded under sub22 section (a) shall not exceed a period of 5 years. 

23 ‘‘(3) ADDITIONAL PERIODS.— 

24 ‘‘(A) EXTENSION.—The period of a grant 

25 or contract awarded under subsection (a) may 


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1 be extended for 1 or more additional periods 

2 not exceeding 5 years if the operations of the 

3 program involved have been reviewed by an ap4 propriate technical and scientific peer review 

5 group established by the Director of NIH and 

6 the group has recommended to the Director 

7 that such period should be extended. 

8 ‘‘(B) AMOUNT.—The amount of any grant 

9 or contract under subsection (a) for an addi10 tional period described in subparagraph (A) 

11 shall not exceed $2,000,000 per fiscal year. 

12 ‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec13 tion shall be construed as precluding or otherwise affecting 

14 funding for any research on eating disorders in addition 

15 to the research funded under this section. 

16 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

17 is authorized to be appropriated to carry out this section, 

18 $20,000,000 for each of fiscal years 2012 through 2016. 

19 Amounts appropriated under this subsection shall be in 

20 addition to any other amounts appropriated for such pur21 pose.’’. 


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1 SEC. 102. EATING DISORDERS SURVEILLANCE AND RE2 SEARCH PROGRAM. 

3 Title III of the Public Health Service Act (42 U.S.C. 

4 241 et seq.) is amended by adding at the end thereof the 

5 following: 

6 ‘‘PART W—PROGRAMS RELATING TO EATING 

7 DISORDERS 

8 ‘‘SEC. 399OO. EATING DISORDERS SURVEILLANCE AND RE9 SEARCH PROGRAM. 

10 ‘‘(a) NATIONAL EATING DISORDERS SURVEILLANCE

11 PROGRAM.— 

12 ‘‘(1) IN GENERAL.—The Secretary, acting 

13 through the Director of the Centers for Disease 

14 Control and Prevention and in consultation with 

15 leading eating disorders researchers and clinicians— 

16 ‘‘(A) shall provide for the collection, anal17 ysis, and reporting of epidemiological data on 

18 eating disorders through the existing surveil19 lance programs of the Centers, such as the Be20 havioral Risk Factor Surveillance System; 

21 ‘‘(B) shall make recommendations to en22 hance existing surveillance programs of the 

23 Centers, such as the Behavioral Risk Factor 

24 Surveillance System, to more accurately collect 

25 epidemiological data on disordered eating and 

26 eating disorders; 


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1 ‘‘(C) may award grants and cooperative 

2 agreements and may provide direct technical as3 sistance to eligible entities for the collection, 

4 analysis, and reporting of such data; and 

5 ‘‘(D) shall examine and improve require6 ments for reporting deaths on death certificates 

7 to accurately account for those cases in which 

8 an eating disorder is the underlying or contrib9 uting cause of death. 

10 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

11 grant or cooperative agreement under paragraph 

12 (1)(C), an entity shall be a public or nonprofit pri13 vate entity (including a health department of a State 

14 or political subdivisions of a State, a university, or 

15 any other educational institution), and submit to the 

16 Secretary an application at such time, in such man17 ner, and containing such information as the Sec18 retary may require. 

19 ‘‘(b) CENTER OF EATING DISORDERS EPIDEMI20 OLOGY.— 

21 ‘‘(1) IN GENERAL.—The Secretary, acting 

22 through the Director of the Centers for Disease 

23 Control and Prevention, shall establish a Center of 

24 Eating Disorders Epidemiology for the purpose of 

25 collecting and analyzing information on— 


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1 ‘‘(A) the number, incidence, incidence 

2 trends over time, correlates, mortality, and 

3 causes of eating disorders; 

4 ‘‘(B) the effects of eating disorders on 

5 quality of life, including disability adjusted life 

6 years (DALY) and quality adjusted life years 

7 (QALY); and 

8 ‘‘(C) economic analysis of the costs of eat9 ing disorders in the United States, including 

10 years of productive life lost, missed days of 

11 work, reduced work productivity, costs of med12 ical and mental health treatment, prescriptions, 

13 other medications, hospitalizations, costs of 

14 medical and psychiatric comorbidities, costs to 

15 family, and costs to society. 

16 ‘‘(2) GRANTS; COOPERATIVE AGREEMENTS.— 

17 The Center of Eating Disorders Epidemiology under 

18 paragraph (1) shall be established and operated 

19 through the awarding of grants or cooperative agree20 ments to one or more public or nonprofit private en21 tities that conduct research, which may include a 

22 university or other educational entity. 

23 ‘‘(3) REQUIREMENTS.—To be eligible to receive 

24 a grant or cooperative agreement under paragraph 

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1 cation containing such agreements and information 

2 as the Secretary may require, including an agree3 ment that the Center of Eating Disorders Epidemi4 ology will operate in accordance with the following: 

5 ‘‘(A) The Center will collect, analyze, and 

6 report eating disorders data according to guide7 lines prescribed by the Director of the Centers 

8 for Disease Control and Prevention, after con9 sultation with relevant State and local public 

10 health officials, private sector eating disorder 

11 researchers and clinicians, and advocates for 

12 those with eating disorders. 

13 ‘‘(B) The Center will assist with the devel14 opment and coordination of State eating dis15 orders surveillance efforts within a region. 

16 ‘‘(C) The Center will identify eligible cases 

17 and controls through its surveillance systems 

18 and conduct research into factors which may 

19 cause or increase the risk of eating disorders. 

20 ‘‘(D) The Center will develop or extend an 

21 area of special research expertise (including ge22 netics, environmental exposures, and other rel23 evant research specialty areas). 

24 ‘‘(c) CLEARINGHOUSE.—The Secretary, acting 

25 through the Director of the Centers for Disease Control 


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1 and Prevention and in consultation with leading eating 

2 disorders researchers and clinicians, shall carry out the 

3 following: 

4 ‘‘(1) ESTABLISHMENT.—The Secretary shall es5 tablish a clearinghouse within the Centers for Dis6 ease Control and Prevention for the collection and 

7 storage of data generated from the monitoring pro8 grams established under this section and part J of 

9 title IV. Through the clearinghouse, the Centers for 

10 Disease Control and Prevention shall serve as the 

11 coordinating agency for eating disorders surveillance 

12 activities. The functions of such clearinghouse shall 

13 include facilitating the coordination of research and 

14 policy development relating to the prevention, treat15 ment, and epidemiology of eating disorders. 

16 ‘‘(2) FACILITATION OF RESEARCH.—The Sec17 retary shall provide for the establishment of a pro18 gram under which samples of tissues and genetic 

19 and other biological materials that are of use in re20 search on eating disorders are donated, collected, 

21 preserved, and made available for such research. 

22 Such program shall be carried out in accordance 

23 with accepted scientific and medical standards for 

24 the donation, collection, and preservation of such 

25 samples, and shall be conducted so that the tissues 


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1 and other materials saved, as well as any database 

2 compiled from such tissues and materials, are avail3 able to researchers at a reasonable cost. 

4 ‘‘(3) COORDINATION.—The Centers for Disease 

5 Control and Prevention shall coordinate research 

6 and surveillance activities of such Centers with the 

7 National Institutes of Health, other appropriate 

8 Federal agencies, and interested nonprofit private 

9 entities, which shall be updated as determined ap10 propriate by the Secretary. 

11 ‘‘(d) DEFINITION.—In this section, the term ‘eating 

12 disorder’ includes anorexia nervosa, bulimia nervosa, and 

13 eating disorders not otherwise specified (EDNOS) (includ14 ing binge eating disorder), as defined in the fourth edition 

15 of ‘Diagnostic and Statistical Manual of Mental Disorders’ 

16 or, if applicable, the most recent successor edition. 

17 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

18 is authorized to be appropriated to carry out this section, 

19 $2,000,000 for each of fiscal years 2012 through 2016.’’. 

20 TITLE II—EDUCATION AND 

21 PREVENTION 

22 SEC. 201. STUDY OF MANDATORY BMI REPORTING IN 

23 SCHOOL. 

24 Not later than 1 year after the date of the enactment 

25 of this Act, the Director of the Centers for Disease Control 


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1 and Prevention, in consultation with the Secretary of Edu2 cation and leading eating disorders researchers and clini3 cians, shall conduct a study and submit a report to the 

4 Congress on— 

5 (1) measuring the body mass index (in this sec6 tion referred to as ‘‘BMI’’) of students for those 

7 schools (at any level including pre-schools, kinder8 gartens, elementary schools, secondary schools, and 

9 institutions of higher education) that are measuring 

10 the BMI of students; 

11 (2) the impacts (both positive and negative) on 

12 students of such measures, including unhealthy 

13 weight control behaviors, perceptions of body image, 

14 eating disorder symptoms, and the incidence of teas15 ing or bullying based on body size; and 

16 (3) the impacts (both positive and negative) of 

17 reporting the results of such measures to the par18 ents of such students. 

19 SEC. 202. TRAINING AND EDUCATION. 

20 (a) IN GENERAL.—The Secretary of Health and 

21 Human Services, acting through the Director of the Office 

22 on Women’s Health of the Department of Health and 

23 Human Services and in consultation with the Secretary 

24 of Education and with the Task Force for Health Profes25 sions established under section 399Z(b) of the Public 


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1 Health Service Act (as added by section 203(a)(2) of this 

2 Act), shall— 

3 (1) expand the BodyWise Handbook and re4 lated fact sheets and resource lists available on the 

5 public Internet site of the National Women’s Health 

6 Information Center sponsored by the Office on 

7 Women’s Health, to include— 

8 (A) updated findings and conclusions as 

9 needed; and 

10 (B) thorough information about eating dis11 orders relating to males as well as females; 

12 (2) incorporate, as appropriate, information 

13 from such BodyWise Handbook and related facts 

14 sheets and resource lists into the curriculum of the 

15 BodyWorks obesity prevention program developed by 

16 the Office on Women’s Health and training modules 

17 used in such obesity prevention program; and 

18 (3) promote and make publicly available 

19 (whether through a public Internet site or other 

20 method that does not impose a fee on users) the 

21 BodyWise Handbook and related fact sheets and re22 source lists, as updated under paragraph (1), and 

23 the BodyWorks obesity prevention program, as up24 dated under paragraph (2), including for purposes of 


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1 educating universities and nonprofit entities on eat2 ing disorders. 

3 (b) AUTHORIZATION OF APPROPRIATIONS.—There is 

4 authorized to be appropriated $1,000,000 to carry out 

5 subsection (a). 

6 SEC. 203. HEALTH PROFESSIONAL EDUCATION AND TRAIN7 ING. 

8 Section 399Z of the Public Health Service Act (42 

9 U.S.C. 280h–3) is amended— 

10 (1) by redesignating subsection (b) as sub11 section (d); and 

12 (2) by inserting after subsection (a) the fol13 lowing new subsections: 

14 ‘‘(b) TASK FORCE ON EATING DISORDERS.— 

15 ‘‘(1) ESTABLISHMENT.—The Secretary, acting 

16 through the Administrator of the Health Resources 

17 and Services Administration and one or more of the 

18 Centers of Excellence receiving funds under section 

19 499B(b), shall establish a Task Force for Health 

20 Professions (in this subsection referred to as the 

21 ‘task force’) comprised of experts in the field of eat22 ing disorders (including researchers, clinicians, care 

23 providers, and experts in eating disorders education 

24 and prevention), individuals with eating disorders, 


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1 and individuals with family members who have eat2 ing disorders. 

3 ‘‘(2) DUTIES.—The task force shall— 

4 ‘‘(A) develop, based on the BodyWise 

5 Handbook and related fact sheets and resource 

6 lists available on the public Internet site of the 

7 National Women’s Health Information Center 

8 sponsored by the Office on Women’s Health of 

9 the Department of Health and Human Services 

10 and updated under section 202(a)(1) of the 

11 Federal Response to Eliminate Eating Dis12 orders Act of 2011, an evidence-based or 

13 emerging best-practices training program for 

14 health professionals on eating disorders; 

15 ‘‘(B) award grants for implementation of 

16 such evidence-based training program; and 

17 ‘‘(C) provide training and technical assist18 ance to grant recipients. 

19 ‘‘(3) REPORT.—Not later than 6 years after the 

20 date of the enactment of this subsection, the task 

21 force shall submit to the Congress and make publicly 

22 available a report on the training program developed 

23 under paragraph (2) and the results achieved 

24 through grants awarded for implementation of such 

25 program. 


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1 ‘‘(c) DEFINITION.—In this section, the term ‘eating 

2 disorder’ has the meaning given such term in section 

3 399OO(d).’’; and 

4 (3) by amending subsection (d) (as so redesig5 nated) to read as follows: 

6 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

7 are authorized to be appropriated— 

8 ‘‘(1) to carry out subsection (a), $1,000,000 for 

9 fiscal year 2012 and $500,000 for each of fiscal 

10 years 2013 through 2016; and 

11 ‘‘(2) to carry out subsection (b), $10,000,000 

12 for each of fiscal years 2012 through 2016.’’. 

13 SEC. 204. EDUCATION AND TRAINING FOR ALL HEALTH 

14 PROFESSIONALS. 

15 Section 399Z of the Public Health Service Act (42 

16 U.S.C. 280h–3), as amended by section 203(a), is further 

17 amended— 

18 (1) by redesignating subsections (c) and (d) as 

19 subsections (d) and (e), respectively; 

20 (2) by inserting after subsection (b) the fol21 lowing new subsection: 

22 ‘‘(c) GRANTS REGARDING EATING DISORDERS.— 

23 ‘‘(1) IN GENERAL.—The Secretary may award 

24 grants to eligible entities to integrate training into 

25 existing curricula for primary care physicians and 


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1 other licensed or certified health and mental health 

2 professionals on how to identify, refer, treat, and 

3 prevent eating disorders and aid individuals who suf4 fer from eating disorders. 

5 ‘‘(2) APPLICATION.—An entity that desires a 

6 grant under this subsection shall submit to the Sec7 retary an application at such time, in such manner, 

8 and containing such information as the Secretary 

9 may require, including a plan for the use of funds 

10 that may be awarded and an evaluation of the train11 ing that will be provided. 

12 ‘‘(3) USE OF FUNDS.—An entity that receives 

13 a grant under this subsection shall use the funds 

14 made available through such grant to— 

15 ‘‘(A) use the training program developed 

16 by the Task Force for Health Professions under 

17 subsection (b)(2)(A), evidence-based findings, 

18 promising emerging best practices, or rec19 ommendations that pertain to the prevention 

20 and treatment of eating disorders to conduct 

21 educational training and conferences, including 

22 Internet-based courses and teleconferences, 

23 on— 

24 ‘‘(i) how to treat or prevent eating 

25 disorders; 


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1 ‘‘(ii) how to discuss varied strategies 

2 with patients from at-risk and diverse pop3 ulations to promote positive behavior 

4 change and healthy lifestyles to prevent 

5 eating disorders; 

6 ‘‘(iii) how to identify individuals with 

7 eating disorders, and those who are at risk 

8 for suffering from eating disorders and, 

9 therefore, at risk for related serious and 

10 chronic medical and mental health condi11 tions; and 

12 ‘‘(iv) how to conduct a comprehensive 

13 assessment of individual and familial 

14 health risk factors; and 

15 ‘‘(B) evaluate and report to the Task 

16 Force for Health Professions on the effective17 ness of the training provided by such entity in 

18 increasing knowledge and changing attitudes 

19 and behaviors of trainees.’’; and 

20 (3) in subsection (e) (as so redesignated)— 

21 (A) in paragraph (1), at the end by strik22 ing ‘‘and’’; 

23 (B) in paragraph (2), at the end by strik24 ing the period and inserting ‘‘; and’’; and 


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1 (C) by adding at the end the following new 

2 paragraph: 

3 ‘‘(3) to carry out subsection (c), $10,000,000 

4 for each of fiscal years 2012 through 2016.’’. 

5 SEC. 205. EDUCATION AND TRAINING FOR SCHOOL AND 

6 HIGHER EDUCATION PROFESSIONALS. 

7 (a) TASK FORCE ON EATING DISORDERS PREVEN8 TION IN EDUCATIONAL INSTITUTIONS.— 

9 (1) ESTABLISHMENT.—Not later than 1 year 

10 after the date of the enactment of this Act, the Sec11 retary of Health and Human Services, in consulta12 tion with Centers of Excellence receiving funds 

13 under section 499B of the Public Health Service Act 

14 (as added by section 101 of this Act) and experts in 

15 eating disorder prevention and treatment, shall es16 tablish a Task Force on Eating Disorders Preven17 tion in Educational Institutions (in this subsection 

18 referred to as the ‘‘task force’’). 

19 (2) DUTIES.—The task force shall— 

20 (A) expand upon and incorporate informa21 tion from the BodyWise eating disorder initia22 tive implemented by the Office on Women’s 

23 Health of the Department of Health and 

24 Human Services to develop and provide training 

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1 tion for students, faculty, coaches, and staff in 

2 kindergartens, elementary schools, secondary 

3 schools, and institutions of higher education; 

4 (B) develop a program of educational semi5 nars on eating disorders identification and pre6 vention for use by grant recipients under sub7 section (b); and 

8 (C) provide training to grant recipients 

9 under subsection (b) on implementing such a 

10 program, including by integration into existing 

11 applicable training curricula. 

12 (b) GRANTS.— 

13 (1) AUTHORIZATION.—The Secretary of Health 

14 and Human Services, acting through the Adminis15 trator of the Substance Abuse and Mental Health 

16 Services Administration, shall award grants to eligi17 ble entities— 

18 (A) to conduct educational seminars on 

19 eating disorders identification and prevention; 

20 and 

21 (B) to make resources available to individ22 uals affected by eating disorders. 

23 (2) EDUCATIONAL SEMINARS.—As a condition 

24 on the receipt of a grant under this subsection, an 


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1 eligible entity shall agree to conduct educational 

2 seminars under paragraph (1)(A)— 

3 (A) in accordance with the program devel4 oped under subsection (a)(2)(B) by the Task 

5 Force on Eating Disorders Prevention in Edu6 cational Institutions; and 

7 (B) taking into consideration educational 

8 materials made available through the BodyWise 

9 eating disorder initiative of the Department of 

10 Health and Human Services and relevant re11 search on eating disorders. 

12 (3) ELIGIBLE ENTITY.—In this subsection, the 

13 term ‘‘eligible entity’’ means any State, territory, or 

14 possession of the United States, the District of Co15 lumbia, any Indian tribe or tribal organization (as 

16 defined in subsections (e) and (l), respectively, of 

17 section 4 of the Indian Self-Determination and Edu18 cation Assistance Act (25 U.S.C. 450b)), or a public 

19 or private educational institution, including an insti20 tution of higher education. 

21 SEC. 206. EATING DISORDER RESEARCH AND REPORT. 

22 Not later than 18 months after the date of the enact23 ment of this Act, the National Center for Education Sta24 tistics and the National Center for Health Statistics shall 


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1 conduct a study on the impact of eating disorders on edu2 cational advancement and achievement. The study shall— 

3 (1) determine the prevalence of eating disorders 

4 among students and the morbidity and mortality 

5 rates associated with eating disorders; 

6 (2) evaluate the extent to which students with 

7 eating disorders are more likely to miss school, have 

8 delayed rates of social, emotional, and physical de9 velopment, or have reduced academic performance; 

10 (3) report on current State and local programs 

11 to prevent eating disorders, as well as evaluate the 

12 value of such programs; and 

13 (4) make recommendations on measures that 

14 could be undertaken by the Congress, the Depart15 ment of Education, States, and local educational 

16 agencies to strengthen eating disorder prevention 

17 and awareness programs. 

18 SEC. 207. PUBLIC SERVICE ANNOUNCEMENTS. 

19 (a) IN GENERAL.—The Director of the National In20 stitute of Mental Health shall conduct a program of public 

21 service announcements to educate the public on— 

22 (1) the types of eating disorders; 

23 (2) the seriousness of eating disorders (includ24 ing prevalence, comorbidities, and physical and men25 tal health consequences); 


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1 (3) how to detect, address, refer for help, and 

2 prevent eating disorders; 

3 (4) discrimination and bullying based on body 

4 size; 

5 (5) the effects of media on self esteem and body 

6 image; and 

7 (6) the signs and symptoms of eating disorders. 

8 (b) COLLABORATION.—The Director of the National 

9 Institute of Mental Health shall conduct the program 

10 under subsection (a) in collaboration with— 

11 (1) Centers of Excellence receiving funds under 

12 section 499B of the Public Health Service Act, as 

13 added by section 101; and 

14 (2) community-based national nonprofit re15 sources that— 

16 (A) support individuals affected by eating 

17 disorders; and 

18 (B) work to prevent eating disorders and 

19 address body image and weight issues. 

20 (c) ANNOUNCEMENT REQUIREMENTS.—In carrying 

21 out the program of public service announcements required 

22 by subsection (a), the Director of the National Institute 

23 of Mental Health shall ensure that such announcements— 


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1 (1) address the full spectrum of eating dis2 orders for both sexes and a variety of ethnicities and 

3 age groups; 

4 (2) do not promote or aggravate eating dis5 orders, such as by incorporating images, specific be6 haviors, or statistics that make eating disorders 

7 seem attractive; 

8 (3) feature— 

9 (A) real people who are or were affected by 

10 eating disorders, including individuals who have 

11 died of such disorders; and 

12 (B) not actors or models in place of such 

13 people; 

14 (4) make clear that— 

15 (A) eating disorders are not a choice, but 

16 are serious and often deadly illnesses; and 

17 (B) individuals affected by eating disorders 

18 need to seek help; and 

19 (5) provide information on how and where to 

20 seek help for the treatment of eating disorders. 

21 SEC. 208. SENSE OF CONGRESS. 

22 It is the sense of the Congress that— 

23 (1) federally funded campaigns to fight obesity 

24 should address eating disorders; and 


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1 (2) federally funded studies on obesity should 

2 include questions relating to eating disorders. 

3 TITLE III—TREATMENT 

4 SEC. 301. COVERAGE FOR TREATMENT FOR EATING DIS5 ORDERS UNDER GROUP HEALTH PLANS, IN6 DIVIDUAL HEALTH INSURANCE COVERAGE, 

7 AND FEHBP. 

8 (a) GROUP HEALTH PLANS.— 

9 (1) PUBLIC HEALTH SERVICE ACT AMEND10 MENTS.—Subpart 2 of part A of title XXVII of the 

11 Public Health Service Act is amended by adding at 

12 the end the following new section: 

13 ‘‘SEC. 2708. COVERAGE FOR TREATMENT FOR EATING DIS14 ORDERS. 

15 ‘‘(a) COVERAGE.—A group health plan, and a health 

16 insurance issuer offering group health insurance coverage 

17 in connection with a group health plan, that provides med18 ical and surgical benefits shall provide coverage for treat19 ment for eating disorders consistent with the provisions 

20 of this section. 

21 ‘‘(b) PROHIBITIONS.—A group health plan, and a 

22 health insurance issuer offering group health insurance 

23 coverage in connection with a group health plan, shall 

24 not— 


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1 ‘‘(1) deny to an individual eligibility, or contin2 ued eligibility, to enroll or to renew coverage under 

3 the terms of the plan, solely for the purpose of 

4 avoiding the requirement of this section; 

5 ‘‘(2) deny coverage for treatment of eating dis6 orders, including coverage for residential treatment 

7 of eating disorders, if such treatment is medically 

8 necessary in accordance with the Practice Guidelines 

9 for the Treatment of Patients with Eating Dis10 orders, as most recently published by the American 

11 Psychiatric Association; 

12 ‘‘(3) provide monetary payments, rebates, or 

13 other benefits to individuals to encourage such indi14 viduals to accept less than the minimum protections 

15 available under this section; 

16 ‘‘(4) penalize or otherwise reduce or limit the 

17 reimbursement of a provider because such provider 

18 provided care to an individual participant or bene19 ficiary in accordance with this section; 

20 ‘‘(5) provide incentives (monetary or otherwise) 

21 to a provider to induce such provider to provide care 

22 to an individual participant or beneficiary in a man23 ner inconsistent with this section; or 

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1 erage under the terms of the plan, solely because the 

2 individual was previously found to have an eating 

3 disorder or to have received treatment for an eating 

4 disorder. 

5 ‘‘(c) OUT-OF-NETWORK PROVIDERS.—In the case of 

6 a group health plan, or health insurance issuer offering 

7 group health insurance coverage in connection with a 

8 group health plan, that provides both medical and surgical 

9 benefits and coverage for treatment for eating disorders, 

10 if the plan or coverage provides coverage for medical or 

11 surgical benefits provided by out-of-network providers, the 

12 plan or coverage shall provide coverage for treatment for 

13 eating disorders provided by out-of-network providers in 

14 a manner that is consistent with the requirements of this 

15 section. 

16 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec17 tion shall be construed as preventing a group health plan 

18 or issuer from imposing deductibles, coinsurance, or other 

19 cost-sharing in relation to treatment for eating disorders, 

20 except that such deductibles, coinsurance, or other cost21 sharing may not be greater than the deductibles, coinsur22 ance, or other cost-sharing imposed on other comparable 

23 medical or surgical services covered under the plan. 

24 ‘‘(e) PREEMPTION.—Nothing in this section shall be 

25 construed to preempt any State law in effect on the date 


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1 of enactment of this section with respect to health insur2 ance coverage that requires coverage of at least the cov3 erage for treatment for eating disorders otherwise re4 quired under this section. 

5 ‘‘(f) EATING DISORDERS DEFINED.—For purposes 

6 of this section, the term ‘eating disorder’ includes anorexia 

7 nervosa, bulimia nervosa, and eating disorders not other8 wise specified (EDNOS) (including binge eating disorder), 

9 as defined in the fourth edition of ‘Diagnostic and Statis10 tical Manual of Mental Disorders’ or, if applicable, the 

11 most recent successor edition.’’. 

12 (2) ERISA AMENDMENTS.—(A) Subpart B of 

13 part 7 of subtitle B of title I of the Employee Re14 tirement Income Security Act of 1974 is amended by 

15 adding at the end the following new section: 

16 ‘‘SEC. 714. COVERAGE FOR TREATMENT FOR EATING DIS17 ORDERS. 

18 ‘‘(a) COVERAGE.—A group health plan, and a health 

19 insurance issuer offering group health insurance coverage 

20 in connection with a group health plan, that provides med21 ical and surgical benefits shall provide coverage for treat22 ment for eating disorders consistent with the provisions 

23 of this section. 

24 ‘‘(b) PROHIBITIONS.—A group health plan, and a 

25 health insurance issuer offering group health insurance 


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1 coverage in connection with a group health plan, shall 

2 not— 

3 ‘‘(1) deny to an individual eligibility, or contin4 ued eligibility, to enroll or to renew coverage under 

5 the terms of the plan, solely for the purpose of 

6 avoiding the requirement of this section; 

7 ‘‘(2) deny coverage for treatment of eating dis8 orders, including coverage for residential treatment 

9 of eating disorders, if such treatment is medically 

10 necessary in accordance with the Practice Guidelines 

11 for the Treatment of Patients with Eating Dis12 orders, as most recently published by the American 

13 Psychiatric Association; 

14 ‘‘(3) provide monetary payments, rebates, or 

15 other benefits to individuals to encourage such indi16 viduals to accept less than the minimum protections 

17 available under this section; 

18 ‘‘(4) penalize or otherwise reduce or limit the 

19 reimbursement of a provider because such provider 

20 provided care to an individual participant or bene21 ficiary in accordance with this section; 

22 ‘‘(5) provide incentives (monetary or otherwise) 

23 to a provider to induce such provider to provide care 

24 to an individual participant or beneficiary in a man25 ner inconsistent with this section; or 


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1 ‘‘(6) deny to an individual participant or bene2 ficiary continued eligibility to enroll or to renew cov3 erage under the terms of the plan, solely because the 

4 individual was previously found to have an eating 

5 disorder or to have received treatment for an eating 

6 disorder. 

7 ‘‘(c) OUT-OF-NETWORK PROVIDERS.—In the case of 

8 a group health plan, or health insurance issuer offering 

9 group health insurance coverage in connection with a 

10 group health plan, that provides both medical and surgical 

11 benefits and coverage for treatment for eating disorders, 

12 if the plan or coverage provides coverage for medical or 

13 surgical benefits provided by out-of-network providers, the 

14 plan or coverage shall provide coverage for treatment for 

15 eating disorders provided by out-of-network providers in 

16 a manner that is consistent with the requirements of this 

17 section. 

18 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec19 tion shall be construed as preventing a group health plan 

20 or issuer from imposing deductibles, coinsurance, or other 

21 cost-sharing in relation to treatment for eating disorders, 

22 except that such deductibles, coinsurance, or other cost23 sharing may not be greater than the deductibles, coinsur24 ance, or other cost-sharing imposed on other comparable 

25 medical or surgical services covered under the plan. 


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1 ‘‘(e) PREEMPTION.—Nothing in this section shall be 

2 construed to preempt any State law in effect on the date 

3 of enactment of this section with respect to health insur4 ance coverage that requires coverage of at least the cov5 erage for treatment for eating disorders otherwise re6 quired under this section. 

7 ‘‘(f) EATING DISORDERS DEFINED.—For purposes 

8 of this section, the term ‘eating disorder’ includes anorexia 

9 nervosa, bulimia nervosa, and eating disorders not other10 wise specified (EDNOS) (including binge eating disorder), 

11 as defined in the fourth edition of ‘Diagnostic and Statis12 tical Manual of Mental Disorders’ or, if applicable, the 

13 most recent successor edition.’’. 

14 (B) Section 732(a) of such Act (29 U.S.C. 

15 1191a(a)) is amended by striking ‘‘section 711’’ and 

16 inserting ‘‘sections 711 and 714’’. 

17 (C) The table of contents in section 1 of such 

18 Act is amended by inserting after the item relating 

19 to section 713 the following new item: 

‘‘Sec. 714. Coverage for treatment for eating disorders.’’. 

20 (3) INTERNAL REVENUE CODE AMEND21 MENTS.—(A) Subchapter B of chapter 100 of the 

22 Internal Revenue Code of 1986 is amended by in23 serting after section 9812 the following: 


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1 ‘‘SEC. 9813. COVERAGE FOR TREATMENT FOR EATING DIS2 ORDERS. 

3 ‘‘(a) COVERAGE.—A group health plan that provides 

4 medical and surgical benefits shall provide coverage for 

5 treatment for eating disorders consistent with the provi6 sions of this section. 

7 ‘‘(b) PROHIBITIONS.—A group health plan shall 

8 not— 

9 ‘‘(1) deny to an individual eligibility, or contin10 ued eligibility, to enroll or to renew coverage under 

11 the terms of the plan, solely for the purpose of 

12 avoiding the requirement of this section; 

13 ‘‘(2) deny coverage for treatment of eating dis14 orders, including coverage for residential treatment 

15 of eating disorders, if such treatment is medically 

16 necessary in accordance with the Practice Guidelines 

17 for the Treatment of Patients with Eating Dis18 orders, as most recently published by the American 

19 Psychiatric Association; 

20 ‘‘(3) provide monetary payments, rebates, or 

21 other benefits to individuals to encourage such indi22 viduals to accept less than the minimum protections 

23 available under this section; 

24 ‘‘(4) penalize or otherwise reduce or limit the 

25 reimbursement of a provider because such provider 


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1 provided care to an individual participant or bene2 ficiary in accordance with this section; 

3 ‘‘(5) provide incentives (monetary or otherwise) 

4 to a provider to induce such provider to provide care 

5 to an individual participant or beneficiary in a man6 ner inconsistent with this section; or 

7 ‘‘(6) deny to an individual participant or bene8 ficiary continued eligibility to enroll or to renew cov9 erage under the terms of the plan, solely because the 

10 individual was previously found to have an eating 

11 disorder or to have received treatment for an eating 

12 disorder. 

13 ‘‘(c) OUT-OF-NETWORK PROVIDERS.—In the case of 

14 a group health plan that provides both medical and sur15 gical benefits and coverage for treatment for eating dis16 orders, if the plan provides coverage for medical or sur17 gical benefits provided by out-of-network providers, the 

18 plan or coverage shall provide coverage for treatment for 

19 eating disorders provided by out-of-network providers in 

20 a manner that is consistent with the requirements of this 

21 section. 

22 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec23 tion shall be construed as preventing a group health plan 

24 or issuer from imposing deductibles, coinsurance, or other 

25 cost-sharing in relation to treatment for eating disorders, 


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1 except that such deductibles, coinsurance, or other cost2 sharing may not be greater than the deductibles, coinsur3 ance, or other cost-sharing imposed on other comparable 

4 medical or surgical services covered under the plan. 

5 ‘‘(e) EATING DISORDERS DEFINED.—For purposes 

6 of this section, the term ‘eating disorder’ includes anorexia 

7 nervosa, bulimia nervosa, and eating disorders not other8 wise specified (EDNOS) (including binge eating disorder), 

9 as defined in the fourth edition of ‘Diagnostic and Statis10 tical Manual of Mental Disorders’ or, if applicable, the 

11 most recent successor edition.’’. 

12 (B) The table of sections of such subchapter is 

13 amended by inserting after the item relating to sec14 tion 9812 the following new item: 

‘‘Sec. 9813. Coverage for treatment for eating disorders.’’. 

15 (C) Section 4980D(d)(1) of such Code is 

16 amended by striking ‘‘section 9811’’ and inserting 

17 ‘‘sections 9811 and 9813’’. 

18 (b) APPLICATION TO INDIVIDUAL HEALTH INSUR19 ANCE COVERAGE.—(1) Part B of title XXVII of the Pub20 lic Health Service Act is amended by inserting after sec21 tion 2753 the following new section: 

22 ‘‘SEC. 2754. COVERAGE FOR TREATMENT FOR EATING DIS23 ORDERS. 

24 ‘‘The provisions of section 2708 shall apply to health 

25 insurance coverage offered by a health insurance issuer 


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1 in the individual market in the same manner as it applies 

2 to health insurance coverage offered by a health insurance 

3 issuer in connection with a group health plan in the small 

4 or large group market.’’. 

5 (2) Section 2762(b)(2) of such Act (42 U.S.C. 

6 300gg–62(b)(2)) is amended by striking ‘‘section 2751’’ 

7 and inserting ‘‘sections 2751 and 2754’’. 

8 (c) APPLICATION UNDER FEDERAL EMPLOYEES

9 HEALTH BENEFITS PROGRAM (FEHBP).—Section 8902 

10 of title 5, United States Code, is amended by adding at 

11 the end the following new subsection: 

12 ‘‘(p) A contract may not be made or a plan approved 

13 which does not comply with the requirements of section 

14 2708 of the Public Health Service Act.’’. 

15 (d) EFFECTIVE DATES.— 

16 (1) The amendments made by subsections (a) 

17 and (c) shall apply with respect to group health 

18 plans and health benefit plans for plan years begin19 ning on or after the date that is 6 months after the 

20 date of the enactment of this Act. 

21 (2) The amendments made by subsection (b) 

22 shall apply with respect to health insurance coverage 

23 offered, sold, issued, renewed, in effect, or operated 

24 in the individual market on or after the date that is 


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1 6 months after the date of the enactment of this 

2 Act. 

3 (e) COORDINATION OF ADMINISTRATION.—The Sec4 retary of Labor, the Secretary of Health and Human Serv5 ices, and the Secretary of the Treasury shall ensure, 

6 through the execution of an interagency memorandum of 

7 understanding among such Secretaries, that— 

8 (1) regulations, rulings, and interpretations 

9 issued by such Secretaries relating to the same mat10 ter over which two or more such Secretaries have re11 sponsibility under the provisions of this section (and 

12 the amendments made thereby) are administered so 

13 as to have the same effect at all times; and 

14 (2) coordination of policies relating to enforcing 

15 the same requirements through such Secretaries in 

16 order to have a coordinated enforcement strategy 

17 that avoids duplication of enforcement efforts and 

18 assigns priorities in enforcement. 

19 TITLE IV—IMPROVING AVAIL20 ABILITY AND ACCESS TO 

21 TREATMENT 

22 SEC. 401. MEDICAID COVERAGE FOR EATING DISORDER 

23 TREATMENT SERVICES. 

24 (a) IN GENERAL.—Section 1905 of the Social Secu25 rity Act (42 U.S.C. 1396d(a)), as amended by section 


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1 2301(a)(1) of the Patient Protection and Affordable Care 

2 Act (Public Law 111–148) and section 1202(b) of the 

3 Health Care and Education Reconciliation Act of 2010 

4 (Public Law 111–152), is amended— 

5 (1) in subsection (a)— 

6 (A) in paragraph (28), by striking ‘‘and’’ 

7 at the end; 

8 (B) by redesignating paragraph (29) as 

9 paragraph (30); and 

10 (C) by inserting after paragraph (28) the 

11 following new paragraph: 

12 ‘‘(29) eating disorder treatment services (as de13 fined in subsection (ee)(1)); and’’; and 

14 (2) by adding at the end the following new sub15 section: 

16 ‘‘(ee) EATING DISORDER TREATMENT SERVICES.— 

17 ‘‘(1) DEFINITION.—The term ‘eating disorder 

18 treatment services’ means services relating to diag19 nosis and treatment of an eating disorder (as de20 fined in section 399OO of the Public Health Service 

21 Act), including screening, counseling, 

22 pharmacotherapy (including coverage of drugs de23 scribed in paragraph (2)), and other necessary 

24 health care services. 


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1 ‘‘(2) COVERAGE FOR PHARMACOLOGICAL

2 TREATMENT OF EATING DISORDERS.—For purposes 

3 of paragraph (1), eating disorder treatment services 

4 shall include drugs provided as part of care in an in5 patient setting, covered outpatient drugs (as defined 

6 in section 1927(k)(2)), and non-prescription drugs 

7 described in section 1927(d)(2)(A) that are pre8 scribed, in accordance with generally accepted med9 ical guidelines, for treatment of an eating disorder.’’. 

10 (b) INCREASED FMAP FOR EATING DISORDER

11 TREATMENT SERVICES.—Section 1905(b) of the Social 

12 Security Act (42 U.S.C. 1396d(b)), as amended by section 

13 4106(b) of the Patient Protection and Affordable Care 

14 Act, is amended— 

15 (1) by striking ‘‘and’’ before ‘‘(5)’’; and 

16 (2) by inserting before the period at the end the 

17 following: ‘‘, and (6) the Federal medical assistance 

18 percentage shall be equal to the enhanced FMAP de19 scribed in section 2105(b) with respect to medical 

20 assistance for eating disorder treatment services (as 

21 defined in subsection (ee)(1)) provided to an indi22 vidual who is eligible for such assistance and has an 

23 eating disorder (as defined in section 399OO of the 

24 Public Health Service Act)’’. 


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1 (c) INCLUSION IN EPSDT SERVICES.—Section 

2 1905(r)(1)(B) of such Act (42 U.S.C. 1396d(r)(1)(B)) is 

3 amended— 

4 (1) in clause (iv), by striking ‘‘and’’ at the end; 

5 (2) in clause (v), by striking the period at the 

6 end and inserting ‘‘; and’’; and 

7 (3) by inserting after clause (v) the following 

8 new clause: 

9 ‘‘(vi) appropriate diagnostic services 

10 relating to eating disorders (as defined in 

11 section 399OO of the Public Health Serv12 ice Act).’’. 

13 (d) EXCEPTION FROM OPTIONAL RESTRICTION

14 UNDER MEDICAID DRUG COVERAGE.—Section 

15 1927(d)(2)(A) of such Act (42 U.S.C. 1396r–8(d)(2)(A)) 

16 is amended by inserting before the period at the end the 

17 following: ‘‘, except for drugs that are prescribed, in ac18 cordance with generally accepted medical guidelines, for 

19 the purpose of treatment of an individual who is eligible 

20 for medical assistance under the State plan and has an 

21 eating disorder (as defined in section 399OO of the Public 

22 Health Service Act)’’. 

23 (e) EFFECTIVE DATE.—The amendments made by 

24 this section shall apply to drugs and services furnished 

25 on or after the date of the enactment of this Act. 


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1 SEC. 402. GRANTS TO SUPPORT PATIENT ADVOCACY. 

2 Subpart II of part D of title IX of the Public Health 

3 Service Act, as amended by section 6301(b) of the Patient 

4 Protection and Affordable Care Act (Public Law 111– 

5 148), is further amended by adding at the end the fol6 lowing: 

7 ‘‘SEC. 938. GRANTS TO SUPPORT PATIENT ADVOCACY. 

8 ‘‘(a) GRANTS.—The Secretary, acting through the 

9 Director, shall award grants under this section to develop 

10 and support patient advocacy work to help individuals with 

11 eating disorders obtain adequate health care services and 

12 insurance coverage. 

13 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

14 under this section, an entity shall— 

15 ‘‘(1) be a public or nonprofit private entity (in16 cluding a health department of a State or tribal 

17 agency, a community-based organization, or an insti18 tution of higher education); 

19 ‘‘(2) prepare and submit to the Secretary an 

20 application at such time, in such manner, and con21 taining such information as the Secretary may re22 quire, including— 

23 ‘‘(A) comprehensive strategies for advo24 cating on behalf of, and working with, individ25 uals with eating disorders or at risk for devel26 oping eating disorders; 


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1 ‘‘(B) a plan for consulting with commu2 nity-based coalitions, treatment centers, or eat3 ing disorder research experts who have experi4 ence and expertise in issues related to eating 

5 disorders or patient advocacy in providing serv6 ices under a grant awarded under this section; 

7 and 

8 ‘‘(C) a plan for financial sustainability in9 volving State, local, and private contributions. 

10 ‘‘(c) USE OF FUNDS.—Amounts provided under a 

11 grant awarded under this section shall be used to support 

12 patient advocacy work, including— 

13 ‘‘(1) providing education and outreach in com14 munity settings regarding eating disorders and asso15 ciated health problems, especially among low-income, 

16 minority, and medically underserved populations; 

17 ‘‘(2) facilitating access to appropriate, ade18 quate, and timely health care for individuals with 

19 eating disorders and associated health problems; 

20 ‘‘(3) assisting in communication and coopera21 tion between patients and providers; 

22 ‘‘(4) representing the interests of patients in 

23 managing health insurance claims and plans; 

24 ‘‘(5) providing education and outreach regard25 ing enrollment in health insurance, including enrollVerDate Mar 15 2010 23:19 Apr 11, 2011 Jkt 099200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\H1448.IH H1448

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1 ment in the Medicare program under title XVIII of 

2 the Social Security Act, the Medicaid program under 

3 title XIX of such Act, and the Children’s Health In4 surance Program under title XXI of such Act; 

5 ‘‘(6) identifying, referring, and enrolling under6 served populations in appropriate health care agen7 cies and community-based programs and organiza8 tions in order to increase access to high-quality 

9 health care services; 

10 ‘‘(7) providing technical assistance, training, 

11 and organizational support for patient advocates; 

12 and 

13 ‘‘(8) creating, operating, and participating in 

14 State or regional networks of patient advocates. 

15 ‘‘(d) REQUIREMENTS OF GRANTEES.— 

16 ‘‘(1) LIMITATION ON ADMINISTRATIVE EX17 PENSES.—A grantee shall not use more than 5 per18 cent of the amounts received under a grant under 

19 this section for administrative expenses. 

20 ‘‘(2) CONTRIBUTION OF FUNDS.—A grantee 

21 under this section, and any entity receiving assist22 ance under the grant for training and education, 

23 shall contribute non-Federal funds, either directly or 

24 through in-kind contributions, to the costs of the ac25 tivities to be funded under the grant in an amount 


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1 that is not less than 50 percent of the total cost of 

2 such activities. 

3 ‘‘(3) REPORTING TO SECRETARY.—A grantee 

4 under this section shall submit to the Secretary a re5 port, at such time, in such manner, and containing 

6 such information as the Secretary may require, in7 cluding a description and evaluation of the activities 

8 described in subsection (c) carried out by such enti9 ty. 

10 ‘‘(e) EATING DISORDER.—In this section, the term 

11 ‘eating disorder’ has the meaning given such term in sec12 tion 399OO(e). 

13 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 

14 carry out this section, there are authorized to be appro15 priated $1,000,000 for each of fiscal years 2012 through 

16 2016.’’. 

Æ 


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